AF - 34927._ . : � �.
land Plannie�g .. ����1G�� 6875 Higl�wdy No.b4 N.H.
land Surveying • �/�� r• ��j Minneaqelis�
Ssil� Ts�11ng � �pi�%�/�i J V%Zri� Mien. !l43Z
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Civll Engiessring � ��� . Tel�pl�n• 784-6086
Municipal Enginesriag ,�agi��aer� BZ S`l1l�i'��''OY't9 Areo Cede 61S
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Certilicate af Survey for �H,.aQt.�-5 t�. Jot-�aNSON � ZNC. _.
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y�;L: �iIY � QF FRIDELIP DOES IdOT GUARdilVTE� fF�F " 1 >����� V�j\�'��
��C,�lRACY OF {J`f1U?Y �OCATi6N5 ?1Rfp �VAt�G:�:�; •.• ���.c��00� ���
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� THiN THIS ARER V'Jti H1JU.
PROVA /PiF� THE CITY OF FR11
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� h��eby te�tlly th+�� thts i• a frus dnd eerrsef represeMfatlen ol a su�vey of the beuhddFios el the a66W
d�se�ibed land, and e+ fhe leeette�+ ef all buildtngy ths�sen� ond ait vi�ible sneroachn�eets� if any� Iron� �r ee
said land. As survsysd by n�e tt�is �'+�dr e! � A.O. 1 .
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� SU�U(tBAN ENGINEERINt3, I�IC.
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J14NIE�S B. &
� T�, INC.
d ,�
�� 9th 8� Sibley St. N.E.
Minr�apolis, Minn. 55413
338-7541
EXTr�SOR Fi�TYLLOPE AVER.AGE "0" C�PUTdTION
OWirl� �t�.� A A��,�- PLAN N0. '%`T /� O
SI'1'E AUDRESS DATE I <`�
B
Determine working squars footage of eac �Y��s ��
� /�
1. Total exposed wall area...... ��'�'�� sq.ft. x�_ ..�p
2. Total roof/aailin� a.rea...... �e�'�¢ sq.ft. x.� _ �(i' �(��r g�v)
3 • TO'f.8�. �.002' /CBYlt'. • $I'98 � � � � � � • 8Q � f t'i • 7C � = �
Total exposed wall area above floor �� ��� %���
8• TO't81 WB�.�. W�l�dW $i�8����������������������• �r+ , �
b. Total. door area .............................. E�
O• TO'tSl 8�3.11g g',1888 door area ................ °'°
d. Total fireplac� wal]. erea ....................
A• TOt81 X$� fP8�A� 8r�8 (aversge 10�)�������� •
� • TOtB�. IIA�'. WSZZ 8I'A8 8�?OV9 �.001' � � � � � � � � � � � � � • r ;+ -�s a c�
g. Total ri.m joiat area .......................... '. �-
Total exposed foundation area � � � � � �"
h. Total fonndation windaw area ................. '.""—
i. Total net font�dation area above grade........ _,�,� �'� . _
Determine "II" nalue of each wall segiment
a. 1 - � x "U" . �5 = 0. �, _,
b. x "II" • ' _ ,
.....
c. � x aII" � _ . �
d. x "D" _
—
e. X "II" � _ _ �� . 9U
Y. . g pII� . a
�. S "IT" � c��A = ' •
h.�� x "U" _
i. � . x "II" _ '` •
Subtotal = .
�. ................................... �o�m = 3 �. ��
If item �4 is the same as� or less than it,sm �1� you have met
the intent of SBC 60Q6(c)2.
L
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¢
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b•
d�
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C��� ���� � ��
Total exnosed wall area abave floor =� 7° �`�
Total arall wi.zx3lo� area ......................... /
TO��. Ci00i� 82'�A����o��������������������������• - -y�c♦ J
TO�1 sliding glass door area ..................
Total fireplace wall area ......................
Total Wa11 framing 82'98 �$4A2'a�9 l�j % � � � � � � � � � • •
Total net wa].1 area abave floor ................
Total rim joi�t 8�I'e8��������������������������•
Total exposed foundation area =
b. Total foundation wi.r�dow area ................... -
i. Total net fourndation area above grade..........
Determine "II" value oP each wall segm�ent.
a. % "U" _
b. � %: � � $ MQn � �� a � e (�'9 ,�-
o. g "U" _
d� g "Q" _
•. �� ° �'� g �p+� i �� �' _ �. / 2
f �,� , ���g p� . � � � _ �3. �3
._.- ,
g• g �Q" �
h. g �oA �
1• X "II" a
, subtotal = `�`'�' ��
`:- " Total exposed roof/ceiling are8 1��� ,
j. Total �ky].ight area .....................................
k. Total raof/aeiling framing area (aver. (.10016"o/c),�.,,
(.062y�4"o/c)... 's• '
1. Totsl net insu7.ated roof�ceiling area .................. -
Determiae "II" value for each roof/cailing segment
.�• ,� g "U" _
k, . x "U" . ., _ .
—
1. a "U" • _ .
5� •������������������������������������������s����• TO�1 � ��I � �
Ii' to'tsl of ��y is the satne as, or leas than �2� you have inet the
iritent of SBC 60�(c)�..
Total expoaed floor/cant. area
m. Total floor/cant. framin area (average .lO;Po)........••
II • Tofi,a]. net insul�ad floor�0811'ti • �2'98 � � � � o � � � � � � � � � � � � � � o
�t,ermine "iT" valae for each floor/oant. segment
m. x "�" a
A. � a0" �
6i •�•�•••��s�•••�••�•••••�•••••••.•.••••••••.•�•••• `rOt81 a
If total.of �6 is the same as, ar less than $3� you have met the
i�tent oF sBC 6006('0)3.
ALT}�iATE BIIILDING t�TVE3APE DESIGN
Td utilize the total eriv�elope system methad, the valuas established
b�' the aum of item� $4, �5 anl all �i be gr'eater than the s
ci' �tems $1, $2 • � / J�� 9'
1. 2�. �78 . , � 3. � .�� •
4; 39�. � 5. �.�� � 6, a . 4�
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4
sue.iecr MIT NO.
c�ty of F��aley � i4593
AT THE TOP OF THE TWIN3 g U I L D I N G P E R M i '
s � ECEIPT NO.
COMMUNITY DEVELOPMEPIT DIV.
i �L ---- I
r � � PROTECTIVE INSPEC710N SEC. • 9Q�p/
' i '
�� ���'1 � CITY HALL FRIDLE� 55432 NUb1BER REV. DATE PAGE OF APOROVEO BY
•"'� � ,� 812-880-3450
910-F15 3/10/?8 � �
JOB ADDRESS 7898 �,den Way N.E.
1 CEGAL ��T NO. BLOCK TRACT OR ADDITION �e�SA � S Cr�1].C)Te1�ly ES'�S't@S ZAtkEE ATTACHED
DESCR. ], tj .�.g�,.��� � SHEET
2 PROPERTY OWNER MAlL ADQRESS 21P PHONE
Richard Keller
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO.
Chas. E. Johauson Inc. 424 Ra.ce Creek Blvd. 571-8Q21
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
a
5 ENf31NEER MAILADDRESS S��RA1E pER��TS. � Z'Pt p PHONE UCEN3EN0.
� V�11
8 USEOFBUILDINO � � ��(�� :9f�i�% S�GAy�, '
R�B�G'11'�].31.
7 CLASS OF WORK
� NEW ❑ ADDITION � ALTERATION O REPAIR ❑ MOTIE ❑ REMOVE
8 DESCRIBE WORK
Construct a 34' x 24' Dwelling and a 24' x 24' Garage
9 CHANGE OF U8E FROPA TO •
STIPULATIONS p��yde a hard s�rface driveway. Provide sod in the front and side
yards. Provide a vera:fyirng swcvey before capping. Pronide "Combustion Air"
to furnace area. Provide truss designs b.y Apri1 6. 1�78.
SE�ER LO(�1TION: (�pprox. 8' Deep in Street) Served from manhole (]:nv. 841.40)
6�3iE EXTENDED 24' FRUM MAN�LE, EXPOSE SERi�ICE AND SET TOP QF FOOTII+�G �LEVAT�QN
3 �'EET ABOVE SERVI�E ELEVA�.'I011T.
WA'P�R LOCATION: 10' North of SeweL^ Service
DRIVEWAY DEPRES5ION CAST: N/A
� un o� r�ro�i+ uoES Hor cu�r� n�� ����%
A�+cu�actr oF ufamr toc�r�av.s �a �v�Yic ��. �. Before di�ging caf! locat ufiirities
TFNS �AiA tS E�QA �1FQRMAi10N PURPOSES ONLY tai��� TE�EPtiONE • ELECTf�IC - GAS ftc.
�lHS US1NG R SH�Ui.D �IERIFY THE tMFQRMAT6�3t� �EC�:�'��� �,� l��
UN THE SiT�.
SEPARATE PERMITS ARE REAUIRED FOR ELECTRICAL, PLUMBING, HEATINd, TMPE OF CONST. OCCt1PANCY GROUP OCCUPANCY LOAD
VE(dTILATINO OR AIR CONDITIONINO. WOOCZ FL�LE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONINO 3Q. FT. CU: FT.
AUTHORIZED IS NOT GOMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION R]_ 1336+576 32,480 Zbta
OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKINf3
1 HEREBY CERTIFY THAT I HAYE READ AND EXAMINED THIS APPLICATION 1' STALLS GARAGES
ANO KNOW THE SAME TO BE TRUE AND CORRECT. AlL PROVISIONS OF LAW3 VALUATION SURTAX
AND ORDINANCES GOVERNINQ THIS TYPE OF WORK WILL BE COMPLIED. $tj7� 12rj $Z�. S(
WIT'H WHETHER SPECIFIED HfRHN OR NOT. THE GRANTINd OF A PERMIT
DOES WOT PRESUME TO OIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHE STATE OR LOCAL LAW REGULATING CON- $129 � 92 y��OO.00
STRU O OR THE PE ANCE OF CONSTRUCTION. �
� PIAN CHECK FEE 70TAL FEE
� a,y�g,o....� //0`7 32.48 $585.96
SI6NATUREOFC a ACTORORAUTHQHIZEOAGENT IDAT � � WHEN PROP RLY VAUDAT D THtS, IS YOUR PERMIT
��� � �o-�P
SI�NATUREOFOWNERIIFOWNERBUILDERI IOATE! �� BLDG.INSP DATE
i�r ' ' .
�
�
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CITY ar- r-�zzu�cY .
' APPLiCt1TI01�� FO�t (2�SIll(=NTI/1L IIUILDIPIG PE(21�IITS
' � ��L"W, �LTL" R/1T l Ofd S, nDll I T I OIJ�, OR RE PA I RS )
����� .1'�:`�y
�
owc»cR: � l��r�a,v %i�� ,LL � � - i3UILU�Ii: _ C�,�1 s . �" , o � �,� so � ��� �
Ac�dzess : ' Addxess : y� y %�% �' �/i�'/.r "� ���o .
. Tel . t�to . : � �/ - �� �-/ � �
No. : �8�� Street: ^_�� G�i' 4� .
LOT: � BIACY.: � ADDTTIOPJ: ��C�� � o � �
COIWER LOT: �^ INSIDE IAT: SLTI3ACY.: 3�`- SID�YARDS: / D- ?
Applicart attach io L-his form Tvo Certiiicates of Survey of Lot and proposed
bui.lding locaL•ion dra�m on these Certificates. •
DESCRI PTTOIV OF BUI LDI I�G
i
To Be Used l�s: ,
��'._S, : y�� -
Front: 7� Depth: • �� Height: �
Square Feet: �,3r�% Cubic Feet: ��/ %�
��
� Front: � P� Depth: Z Height: 1�
' fiquare Feet: ��� _ _ Cubic Feet: ��� �
0
Type of Construction: W� ���7�Q� Estimai-ed Cost: $ • r----.� �
. � �j. �1°�0 ��c �
?b Be Completed: ��` Alt. A Alt. B �� .
�
Pxciposed Drive�vay [r'idth If New Opening Is Desired � $ $ '
x�O � (S]T� R�VERSE SIDE OF SFiEET)
U''
e undersigned hereby niakes application for a pexmit for the work lierein
specified, agreeing to do all work in strict accardance �vith the City of
Fri.dley Ordinances and rulings of the Department oi Suildings, and hereby
aeclares tha� all the facts and representations stated in L-his application
are true and correct. See reverse side io a itional 'ifozmation.
. !� � a
DATE: � _ SIGATATUI'.E:
� �
s�3pulations : , /oZ 9 9�.
/���'1fh�E ���� �Su.S!'/� ,�<� �
� �r� ��E ����4 �
' � �,���►<�� y"� �� � �s
� �}���y�� � �j
� �Gis�y � ,�� 'y/��/f��
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BUILDIf�G PERMIT FEE SCHEDULE
SECTION Z. The Inspector of Buildings shall, before issuing permits for the erection
of any building or structure, or for any addition to any existing building or structure,
or for any alteration or repairs to any existing building or structure, upon application
therefore, require� the payment by the applicant for.such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet.
PLAN CHECK: 25 percent of building permit fee.
DRIVEWAY DEPRESSION: (Concrete Curb Streets Only)
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x$14.50
Alternate B: Removal and replacement of concrete curb and
gutter and i.nstall a 3 foot wide approach with
6 inch depth; Driveway width plus 6 feet x$17•20
�11 ��� � !' � �l
For the purpose of com,puting fees for building permits, the cubical contents of any
building or addition, is determined by multiplying the ground area covered from a
point six (6) inches be].ow the floor line of the basement or th� cellar to the
average heights of the upper surface or to the average height of the roof surface
of the main gable of a pitched roof.
For repai.rs or alterations to an existing structure, the fee shall be at the rate
of $3.00,�ier each five hundred dollars ($500.00) or fraction thereof i.n the cost
of all proposed work.
In•no case shall the fee charged for any permit as set forth in Section 2 be less
than $7.50 plus $.50 state surcharge.
��l i ' � � 1 � �� � 1
NOTE: Permits for construction will be issued a minimiun of 24 hours from the time
of application to allow for proper review of the proposed structure and of the
construction site.
A Certificate of Suzvey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
i � � 1 �•�
Application for a Certificate of Occupancy shall be made ten (10) days prior to the
use or occu,pancy of any structure for which a building pexmit has been issued; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
f
>m. . -�. sac� ,�..�
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: . �1. �are�s ' . �7� �� � c� �. .
� - � a. z��i . ,�� . i , �� -� � ��
. �. �� • ,� ,�
. . 4. Lot �Width � �"�. � � . . � -
. � 5. � Huilding ididth � �L �
. � 6.. Front� setback � �3 g . � .
� • � 7. Tatal Use (� . � .
8. � Lot �Cov�rage � � �o?b`�a , •
. 9. �Ease�uents . � �6C. � • � . • •
� Variarice ' � : 11��� .
� �� Soil ?
" � 12. Contracto���� •
t: . 13 . Phone . ,g % -. � �; �
. .1 . Architec� �, ti��Q�.�' �
15 Drainage. � �
6. Energy Ashrae � � . �
Z7. tlti3ity Locations .
I . Specials � . , •
19 ivehray opening . � .
. - . � ss �sign � �
Cc�mbustion Aix • ' .
� � 22... . . � � . � � ..
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Mam OHice 57i�066
� YBYROAN 6875 Mighwey Plp. 65.N.E.
��MOINa�RINO Minneapolis. Minnesotafi5432
�pc
South OHice 89f16510
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8urmville. 0.Amrmsota 55337
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- cor�n. Oated Mis�dor of �%� A. D. 19�? �
SUdURB E INB� G, INC.
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6431 UNIVERSITY AVENUE N.E.� FRIDLEY� MINNBSOTA SS432
TELEPHONH ( 812)571-3450
ust 30, 1978
Louis St. Marie
St. Marie Sheet Metal Inc.
7940 Spri ng Lake I�oad
Minneapolis, N1DT 55432
Re: Heati� Permits
Dear Louis:
Thi.s is just a reminder to you that we would appreciate your sending
in the applications for the heating work you are doing in Fri.dley, and in
particular for the work at 7898 A7.den Way that is nearly complete.
We are enclosing_applications in case you have used all you had.
Sincerely,
BILL SANDIN
Pltmtbing-Heating Inspector
BS/mh
ENC: 6
. ;. .
0
��
�
City of Fridley
AT TME TOP OF TME TWIN3
i �
� �
� ; y ����� � COMMUNITY DEVELOPM�NT OIV.
r � � PROTECTIVE INSPECTIqN SEC.
i = �
� �"'f � CITY MALL FRIOLE� l�.S' �32
�----� • •,, 612-571-3450
JOB ADDRESS 7898 A1den Wa
t LEGAL LOT NO. BLOCK ; tHAC'
DESCR. 1 4 Pea�
I�CGT .
�U ILDING PERMIT
ie�, REV OATE PAGE Oi
s�aF�s 9/21/99 / /
G
� CONTRACTOR MAIL ADDfiESS ���'
Westurn Roofing 9700 13th Ave N Plv�uthl��T__55441 54.1-
d ARCNITECT OR DE31(iNEii MAI ADORESS Z�P
S ENGINEER MAILAQDRESS , Z�P
8 USE OF BUILDIN(i
Residential
7 CLASS OF WORK '
❑ NEW � ADDITION ❑ ALTERATION x� REPAIR
8 OESCRIBE WORK
Reroof house and garage.(35 Sa) Tear-off
9 CHANdE OF USE f
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTiiICAL, PLUMBING, HEATING, ��re vr �
VENTILATING OR AIp CONDITIONIN(i.
TMiS PERMIT BECOMES NUII AND VOIO iF WORK OR CONSTRUCTION ZONIHG
AUTHORIZEO IS NOT COMMENCEO V�IITHIN 80 OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONEO FOp A PER100 OF ��p DAYS A17
ANY TIME AFTER WORK IS COMMENCED. NO. OWt,
1 HEREBY CERTIFY TMAT I MAVE REAO ANO FXAMIN�O TMIS APPLICA710N
ANO KNOW TME SAME TO 8E TRUE AND CORRECT. ALL PROVISICNS qF L,AWS 'VALUATIC
ANO ORDINANCES GOVERNING TMIS TYPE OF W(aRK WILI �E GOMP�IEO �3059
WI7M WMETMER SPECIFIED MEiiEIN OR NOT. TNE GFIANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTMOqITY TO VIOI.ATE OR CANCEL THE pE MIT FI
PROVISIONS OF ANV OTMEFi STATE OR LOCAI LAW REGUTATIN(3 CON•
STRUCTION OR THE PERFORMA CE OF CONSTRUCTION �9%. ZS
PLAN CME
� T.S ��� � Licens
�GN4TUfiE O� CON: RACTOp Op pUTMOp�2E0 �16ENT IOAT�� �
&GNAfUAEO�OWNEA���OWNEN8U�L0ENi �OATEi � wi
STALLS
30259
SEE ATTACMEO
ShIEET
PMONE
57l-A.l�l
PMONE LICENSE NO
a �o�ss�titi
PMONE LICENSE NO.
PMONE LICENSE NO
O MOVE O REMOVE
OCCUPANCYLOAO
CU. FT.
IEET PARKING
IGARAGES
$1.53
SAC CMAqGE
Fire SC 3.06
07AL FE
.00 $10 4
IDATEO I%S �R PEpA
, �/' �_ `7i/�
` �
NEW � �
ADDN
ALTER
Effective 5/10/99
[ ] CITY OF FRIDLEY
[] SINGLE FA1V�.Y AND DUPLEXES R 1 AND R 2
BUII,DING PERMTT APPLICATION
Construction Address: % � �
L.egal Description:
�
Owner Name & Address: �.i�,�►caf•�. ��-G���,�'" "7�g �' ��c�+cv� �e��Tel. # v�% 1 ''�f %1
Contractor: �L° ��.iC� �a �tr�e .MN LICFNS� �--;ZQ��S�C�a%Q
Address: �% C�O 1�3 �'' �.�(-e -!�• C.-.�- �le� r[ Tel. #� g�,%f' b 3DC-�
Attach to this applic,�tic�n,��:�ertificate �of_Snrve�►..;af f� _ ._
lot, with the pro�osedF:c�nstc�cti�n�.dra�.�n it to scale: -
LIVING AREA:
GARAGE A.REA:
DECK AREA:
01'HER:
Length
�
Length
Length
DESCRIFTION Q�`I1�PItOVEMENT
Width
Width
Width
_ Height
= Height
_ Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
��� 7
Construction Ty�: �; Estimated Cost: $.�� . 7_ � C,� .�'�
Driveway C�rb C�ut Width Needed: Ft. + 6 Ft = Ft x$ __$ �
DATE: -'Z 1 ''� APPLICANT: Tel. # $��-J % �-O��
Permit Fee
Fire 5urchazge
State Surcharge
SAC Charge
License S�rcharge
Driveway Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ /, �.� Fee Schedule on Reverse Side
$ . 0 � .001 of Permit Valuation (1/lOth%)
$ � ,S $.50/$1,000 Valuation
$ $1050 per SAC Unit
$ . . .. ,� - D O . �5.00 (State Licensed Resident�l Contract4��: _
$ Alt. "A" or Alt. "B" Above
$ $450.� Conservation Plan Review
$ Fee Determined by Engineering
$ Agreemern Necessary [ ] Not Necessary [ ]
$ /D� - �
r " " ...
BUII..DING PERNIIT FEE �CHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for an,� .a�teration or repair to any e�sting building or st�vcture,
upon application therefore, require the payment by -th�.:�gp�ir�nt for suc� permit of fees to the amount herein
below set forth and in the manner herein provided to-wit: �. a '
$1
TOTAL VALUE
to $540
$23.50
FEES
� . _ � . . . � � �<< �
$501 to $2,000 $23.50 far first $5� plus $3.OS.sfor each additional $100 or
fraction therecaf,:to and.inchiding $2,�0
$2,�1 to $25,000
$25,001 to $50,000
$50,001 to $100,�
$100,�1 to $500,000
$5�,001 to $1,000,000
$1,000,001 and up
$69.Z�:for first $2,000 plus $14.00 fQr each addirional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional$1,000
or fraction. ther.eof, to and including $50,000 -
$643.75 for first $50,0� plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $1�,000 pl�s $5.60 for each additional
$1,000 or fraction thereof, to and including $5�,000
$3,233.75 for the first $500,�0 plus $4.75 for each additional
$1,000 or.fractit�n thereof, to and including $1,000,0(� �
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,0� or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete G�rb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B"c Remo�aLa�d�eplacement of curb andF:�tt�er and inst�ll��� foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been const�ucted will
be required before proceeding with the framing.
Building MECHANICAL Permit Ivo.�
Inspections RESIDENTIAL APPI,ICATION Received By:
763-572-3604 CITY OF FRIDLEY '
763-502-4977 FAX ����
EFFECTIVE 2-19-09
DATE �C? iG! YOURE-MAILADDRESS �ii���� ��Ai�UL.f7�".Clj!'1��
SITE ADDRESS �
THIS APPLICANT IS: 0 OWNER �(CONTRACTOR
PROPERTY NAtvtE:--_ /f /�E/�t,t� /� t'�"�L�. �+'s'�
TNANT ADDRESS: '��� �GDI��✓ G�//%� CITY/��i�/T���% STA��ZIP�Z
PHONE: �lo.�� '�%'�/-O�`��
CONTRACTOR COMPANY NAME: _{J�����Ai�'ttllt �t��w m.w __ _„
SUBMIT A COPY OF CONTACT PERSON: _ tII�#�A:....a.. e� n� ____
YOUR STATE STATE LICENSE # � �i►� ��t
LICENSE WTfH ADDRESS: �17�'!1 �1gp �crsa CiTY STATE ZIP
APPLICATION pHONE � � ''=%7Z�"' �6.��.
PERMIT TYPE ��GLE FAMILY 0 TWO FAMII.Y ❑ TOWNHOUSE
TYPE OF WORK• � NEW �.REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK �����i� (,LK' �°� � �,
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
Equipmentinstalled MFG: ,�,r��' MODEL: �-���a6,�' SIZEJBTU 3�.�
MFG: �� MODET.: �G� SIZE/BTU _ ��� ��
MFG: MODEL: SIZFJBTU ,
A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGF/OVEN $10.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
BOILER $35.00 liFC1RNACE $35.00 GAS UMT HTR $10.(�
_CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $I0.00 GAS PIPING $10.00 VENTILATOR $I5.00
Number of fixtures @ $10:00 x $10.00 = $
Number of fixtures @ $15.00 x $13,00 = $
� x
Number of fixtures @ $25.00 / x $25.00 = $ � �
Number of fixt�ues @ $35.00 � x $35.00 = $
State Surcharge = $ ��0�:39- _ . �' '
INIMUM FEE $35.50 Tota1= $ �.�'•v�
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the informaYion above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME ✓�'%�IL� ���'� DATE� �/L�
PLEASE NOTE: SEPARATE PERMITS -ARE RE iJTRED FOR BUII:DING,�EI;EC'TRICAI;;`AAiD�1VIECHANICAL WORK
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977 �. .�� ����,..�
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